The Emergency Department (ED) is the front door to a hospital and can account for 50 percent of inpatient admissions. One way to improve patient safety and quality of care and contain costs is to track and document ED patient treatment in a complete electronic medical record that ensures comprehensive patient evaluation and continuity of care. The objective is to successfully implement and formally evaluate a contemporary, web-browser-based electronic record system called the Ibex PulseCheck(r) emergency department information system at two small, county-owned, community hospitals and one medium-sized community hospital in southern Indiana, one rural hospital in central Kentucky, and three private primary care physician practices in Indiana. The lead partner, Jewish Hospital, is a tertiary-care, urban hospital in Louisville, Kentucky, to which the smaller hospitals refer patients. The Jewish Hospital ED has already implemented the Ibex ED information system and has the institutional experience to diffuse this technology to the small community hospitals to create a network for ED data sharing. The four specific aims are to: 1) implement the Ibex ED information systems and train users at four hospitals and three physician groups during three years, 2) evaluate the reduction in medical errors (improper discharges) and waiting time in the EDs, 3) evaluate the reduction in costs through improved diagnostic coding and billing and fewer repeat tests, and 4) evaluate patient and physician satisfaction. Data gathering will be sequential to ensure a large sample size before (paper) and after (paperless) Ibex implementation. The lead partner, the four unconnected, paper-based emergency departments, and the three physician offices will no longer be islands of information but will be connected into an integrated, eight-facility, bi-state, urban-rural, data- sharing ED health information network. [unreadable] [unreadable]